People have a sort of love-hate relationship with winter. We tend to love winter sports, like skiing, snowboarding, sledding, and snowball-pelting. But driving around on icy roads is anything but enjoyable (unless you actually enjoy unintentional 360s on the highway), and winter is, let’s face it, just darn cold. The truth is that as fun as building snowmen and snow forts can be, the cold of winter can actually be dangerous, particularly to the parts of our bodies that are furthest from our cores (like our hands and feet) and those most exposed to the cold (like ears and noses). In fact, nearly half of all frostbite cases involve the feet and ankles. If your body is exposed to cold temperatures long enough, particularly if you have circulation problems (like you do with diabetes), you may develop frostbite.

Your body has a good deal of water in it, but like any water this fluid can develop ice crystals when it gets cold enough. Ice crystals can rupture cell walls and cause cell death, and they usually form in parts of the body that have restricted bloodflow. It’s not exactly something you want to have happening to the water in your body. So, once you’ve gotten ice crystals in your extremities, you officially have frostbite.

Frostbite can vary in severity. Mild frostbite affects just the skin, although as it progresses, it will start to affect deeper tissues such as nerves, muscles, and bone. If very serious, frostbite can result in tissue death (gangrene) and amputation.

The first warning sign of frostbite is a prickly sensation in the affected body part, or mild irritation or pain in your skin. Your skin will probably look pale and feel cold. (If thawed at this point, your frostbitten skin will likely be red and painful.) As the frostbite gets worse, you may experience some dull throbbing or aching in the area, followed by numbness. You may also develop blisters, and the skin of the affected area will probably look white. Eventually, as deeper and deeper tissues are frozen, the whole area will become insensate (lose all sensation), and will feel solid, like a block of wood. Once blood vessels have been frozen, the area may blacken and die.

Obviously, warming up the affected body part is important in administering first aid. However, if you’re unable to keep the body part warmed up before getting medical help, it’s probably best to wait to warm it until afterward, since damage can be worse from re-freezing than from the original frostbite itself.

First of all, you’ll want to get somewhere warm and seek medical attention as soon as possible. Remove any wet clothing, since wet clothes provide almost no insulation from the cold, and can actually draw heat away from the body. Wrap the affected area (in this article, of course, the focus is on the feet) in sterile bandages.

If medical attention isn’t available immediately, you’ll need to warm up the feet yourself. Immerse them in warm (NOT hot) water (about 100º Fahrenheit) for about 20 to 30 minutes (keep warm water circulating to maintain the temperature) until you’re able to feel your feet fully again. Warning: You’ll likely experience burning pain as sensation returns. Fully thawed feet will have soft (not hard, frozen) skin and will have regained color. You can also repeatedly apply warm cloths to the affected area if you cannot immerse it.

1) DON’T go around walking on your feet, either. You should really not move the frostbitten area at all if you can help it.

2) DON’T use direct heat like a fire or hair dryer, since the numbed tissue won’t be able to feel the heat, and can be burned easily.

3) DON’T try to warm your feet by rubbing or massaging them, since this can actually seriously damage frozen tissue.

5) DON’T smoke or drink alcohol while you recover from frostbite, since both can impair your circulation and slow or prevent full healing.

You can do a lot to prevent frostbite, including the following:

1) DO check the weather. If temperatures are expected to be extremely cold, particularly wet or especially windy, you may want to reschedule your winter excursion for another time.

2) DO wear dry, well-insulated clothing for the outdoors. Avoid tight clothing and cramped conditions, since these can reduce blood flow and make you more prone to frostbite. Wearing mittens (rather than gloves), putting on clothing that resists wind and water, layering your clothes, donning two pairs of socks, and sporting winter hats and scarves are all good ideas when the weather gets chilly.

3) Do avoid smoking and alcohol before going out (and while you’re out), since this can affect your circulation and make frostbite more likely. Some medications and medical conditions (such as diabetes) can also reduce circulation. Discuss these with your doctor for recommendations on dealing with cold temperatures.

4) DO stay hydrated and get plenty of rest.

5) If you do start to feel pain or tingling in your extremities – DO find a warm place as soon as you can. If you’re caught in a snowstorm, keep up physical activity to keep your body warm and seek shelter as quickly as possible.

There’s really no reason why you shouldn’t enjoy winter. (Even if shoveling snow is on your list of the 10 worst activities ever.) Just prepare yourself properly for the cold, and winter won’t be your enemy—it’ll be more like the weird uncle who comes a little too early and stays a little too long at family gatherings, but sometimes has pretty good stories to tell.

The Author:

Dr. Marble has more information about other foot and ankle skin conditions on his website. Visit http://www.puebloankleandfoot.com for more free information about these conditions. Dr. Marble is a podiatrist who lives and practices in Pueblo, Colorado.